Beliefs, Attitudes and Behaviors of Healthcare Professionals Regarding Seasonal Influenza Vaccination: An Umbrella Review

Background: Seasonal influenza remains a major public health challenge worldwide, causing significant morbidity each year and imposing substantial burdens on individuals, healthcare systems and national economies. Vaccination is considered the most effective available strategy for prevention; however, uptake rates vary considerably across countries, with many failing to achieve the recommended coverage levels. The aim of this review is to examine the beliefs, attitudes and behaviors of healthcare professionals worldwide regarding seasonal influenza vaccination. Methods: This is an umbrella review, according to the PRISMA Statement 2020, searching PubMed, Cochrane Library and Google Scholar. The following search terms were used: beliefs, attitudes, behaviors, influenza vaccination, flu vaccine, health professionals, primary health care. Selection criteria were the following: 1) Reviews, 2) Published after 1/1/2000, 3) English language 4) Healthcare professionals as target-population. Results: Twenty-five studies met the selection criteria and were included in this review. Twelve out of 25 studies were systematic reviews. Globally, vaccination uptake among healthcare professionals remains below recommended national and international targets. North America demonstrates the highest vaccination coverage, while the lowest coverage is reported in Africa and South America. Overall, low- and middle-income countries show significantly lower vaccination behavior compared with high-income countries. Attitudes and beliefs appear to shape vaccination behavior in high-income countries. The main driver of acceptance is perceived protection of oneself and family, whereas hesitancy is mainly driven by concerns about side effects and vaccine safety. Across studies, non-physician healthcare professionals consistently demonstrated lower influenza vaccine acceptance compared with physicians while pediatricians and general practitioners were found to receive the influenza vaccine more frequently. In addition, younger physicians and those with fewer years of professional experience showed higher vaccination coverage and a greater likelihood of recommending influenza vaccination to patients. Conclusions: Vaccination coverage, worldwide, is lower than what is recommended by the World Health Organization. Healthcare professionals, working in hospital settings, tend to be vaccinated at a higher rate and are more likely to recommend the vaccine to their patients. The recommendations that health professionals give are influenced by whether they accept influenza vaccines themselves. Beliefs and attitudes seem to influence behavior in countries where structural barriers, such as limited access to primary healthcare and socio-economic status are absent.